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confusion over resistance
Oct 24, 2002

For all intensive purposes We are told that mutations leading to antiviral resistance is bad.I am confused though.Lately I have been hearing that resistant virus's are "less fit" weakened by the barrage of antivirals, so it's not all bad.What bearing does having a virus that doesn't mutate and confer resistance though? The reason I ask is I did a dumb dumb thing along time ago and only took very small amounts of antivirals(no where's near prescribed dosing) for almost a year.what I don't understand is I really should have developed resistance I think, to the three drugs that were at suboptimal levels and it turned out that no resistance conferred to those or anything else.So I was super lucky in that respect and I'm surely happy for that,but does that somehow mean my virus is an enigma, that it is a more virualent strain?My other question regards viral fitness.Since the virus essentially incorporates itself into human dna and becomes a part of your genetics more or less(correct me if this is wrong)does that mean that if you have a stronger than normal immune system that somehow the body gives the virus more strength also.I guess what I'm driving at is the discordancy issue.All is well with meds, but I am looking at other avenues(therapuetic, sti, etc) and it just seems that without treatment of course my viral load rises but so do the cd4's(not discordant on meds low/no vl high cd4).Any thoughts on this?Also during that year of "hocus pocus" my cd4's stayed very high(didn't budge) and my vl did rebound but at a VERY low amount<5000.Does this mean anything other than shear luck?(I had a previously high treatment naive baseline vl, but the cd4's were also always in a good safe range)Thank you

Response from Dr. Young

Thanks for your question.

Firstly, I can't think of a situation where drug resistance is a good thing. Clearly it is related to treatment failure and increased risk of disease progession, and even death. Avoiding resistance, though adherence, potent medictations, etc is a very important goal of treatment.

What you have heard about is the question about whether all resistance mutations have equivalent negative effects. There is a growing appreciation for the fact that certain mutations in HIV are associated with virus that, in the presence of drugs, grows more slowly than the wild type virus. The implication (not proven, yet) is that this behavoir confers an improved prognosis for the person infected with this variant virus. One commercial laboratory group (Virologic) has developed an assay to measure this "replication capacity". The appropriate use of the assay and it's clinical meaning remain to be fully determined, but, for the reasons above, has generated much interest.

I hope this helps answer your question. -BY



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